Future Bundled Payment Models Need To Engage Physician Group Practices

Health Affairs | April 4, 2024

The Centers for Medicare and Medicaid Services (CMS) remains committed to episode-based payment models as part of its multidimensional strategy to advance accountable care. Its most recent bundled payment program, Bundled Payments for Care Improvement (BPCI) Advanced, has been extended through 2025. In 2023, CMS announced plans to develop a new mandatory model that builds upon lessons learned from earlier programs, which have demonstrated care transformation and reduced spending while maintaining high-quality outcomes for many episode types. Early reports from BPCI Advanced have also reported reduced spending, although bonus payments yielded net losses for Medicare. A major question for CMS is how to best coordinate bundled payments with population-based approaches, such as accountable care organizations (ACOs). Early indications are that CMS anticipates making the new model mandatory. Yet, if this were to be the case, the future of bundled payments risks losing a major player—physician group practices (hereafter physician groups).

Health care organizations collaborate on best practices for value-based care

Medical Economics | April 10, 2024

A new volume outlines the best ways to find success as health care entities integrate value-based care arrangements into their operations. The American Medical Association, the National Association of ACOs (NAACOs) and AHIP, the trade group representing America’s health insurance payers, collaborated to publish“Creating a Sustainable Future for Value-Based Care: A Playbook of Voluntary Best Practices for VBC Payment Arrangements.” The 74-page guide was announced April 10, the day before NAACOs’ two-day spring conference begins. “In the last decade, value-based care has grown from almost nothing to undeniably significant aspect of our health system,” including accountable care organizations making up 20% of Medicare, said NAACOs President and CEO Clif Gaus, ScD, said in a statement. “This iteration of the playbook synthesizes what we’ve learned over the last decade plus, so that payers, physicians, hospitals, and ACOs can implement payment and delivery models that improve outcomes and lowers costs.”

Navigating the ACO landscape: A guide for providers striving for value-based care

Physicians Practice | April 4, 2024

In the ever-evolving healthcare landscape, primary care practices and federally qualified health centers are facing a significant shift as the Centers for Medicare & Medicaid Services (CMS) continues to push towards its goal that all Medicare Beneficiaries be under a value-based contract by 2030. Moreover, providers are faced with constant challenges in maintaining sustainable practices with ever increasing administrative burdens, staff shortages, and increasing operational costs. This has prompted a surge in interest among providers to join an accountable care organization (ACO) to access shared savings via new payment models. However, the crucial decision of which ACO to join requires careful consideration of various factors.

RISE National 2024: What We Learned

Edifecs | April 2, 2024

The annual RISE National Conference offers an opportunity for mid- to senior-level executives from managed care organizations (MCOs) to come together, share insights and perspectives, and learn about the trends and technologies shaping the healthcare industry. Here are some of the key insights we learned at RISE National 2024. RISE National 2024 featured keynote addresses from the OIG, DOJ, and CMS on the regulatory landscape. In her address, Inspector General Christy Grimm reiterated that no one is immune from regulatory scrutiny, and the OIG is prepared to investigate and penalize any healthcare organization or vendor that fails to comply with CMS guidelines. Overall, this year’s message was similar to last year’s: MCOs are on thin ice. Risk adjustment and prior authorization are still not working as intended, and MCOs must focus on shoring up their processes in both areas to avoid financial penalties or even prosecution.